Telepractice in speech-language pathology: Assessing remote speech discrimination.

PURPOSE: To evaluate adult remote performance in speech discrimination on the Temple Assessment of Language and Short-term Memory in Aphasia (TALSA), and to compare to remote performance in NU-6 word repetition and participant ratings of self-perceived hearing ability obtained via remote session. METHOD: Sixty older adults completed TALSA speech discrimination of concrete, low frequency words and of non-words via telephone. Remote repetition of words controlled for sound frequency was assessed using the Northwestern University (NU-6) word lists administered in live voice and recorded voice conditions. Forty-six of the participants completed questionnaires about their hearing via Zoom videoconference. RESULTS: Mean performance in TALSA speech discrimination for words was similar to performance in NU-6 word repetition. Word repetition of NU-6 lists did not differ significantly for live voice versus recorded voice conditions. TALSA non-word speech discrimination was significantly worse than TALSA speech discrimination for words and was associated with age and self-reported hearing ability. CONCLUSIONS: TALSA speech discrimination can be administered remotely to evaluate potential perceptual influences on auditory comprehension. In remote assessment, participants demonstrated the expected pattern of more accurate speech discrimination for word stimuli than for non-words. The non-word TALSA condition may be particularly useful for detecting speech perception impairment, both in face-to-face and telepractice sessions. Similar performance of participants in both live voice and recorded conditions of the NU-6 word lists suggests that recordings used in SLP receptive language or memory assessment, including the TALSA, need not be abandoned in favor of live voice to support audition during telepractice.

Self-Awareness and therapeutic alliance in speech-language treatment of traumatic brain injury.

Purpose: To investigate the relationships among client self-awareness, client perception of the therapeutic alliance, and speech-language pathologist (SLP) communicative self-awareness in dyads of SLPs and traumatic brain injury (TBI) clients.Method: Nineteen SLP-TBI client dyads (N = 38) engaged in the same collaborative therapy task. At baseline, client self-awareness and client perception of the therapeutic alliance was assessed. SLP communicative self-awareness was measured by 1) a prediction/reflection questionnaire about their own communicative behaviour, administered pre- and post-treatment sessions, and 2) self-evaluation during a novel procedure using video review within three hours after the session.Result: Client self-awareness was not associated with client perceptions of the therapeutic alliance. Client perceptions of the therapeutic alliance were related to specific communicative intentions of the SLP. Regarding SLP communicative self-awareness, SLPs predicted their primary communication modality with 66% accuracy. The video review procedure yielded more detailed SLP communicative self-awareness ratings and was completed within real-world clinical settings.Conclusion: TBI client self-awareness may not impact the establishment of a strong therapeutic alliance between SLP and client. The finding that specific communicative intentions of the SLP were related to client perception of the therapeutic alliance should prompt further efforts to measure SLP communicative intentions and behaviours during TBI treatment sessions.

Music, Math, and Working Memory: Magnetoencephalography Mapping of Brain Activation in Musicians.

Musical transposing is highly demanding of working memory, as it involves mentally converting notes from one musical key (i.e., pitch scale) to another key for singing or instrumental performance. Because musical transposing involves mental adjustment of notes up or down by a specific amount, it may share cognitive elements with arithmetical operations of addition and subtraction. We compared brain activity during high and low working memory load conditions of musical transposing versus math calculations in classically trained musicians. Magnetoencephalography (MEG) was sensitive to differences of task and working memory load. Frontal-occipital connections were highly active during transposing, but not during math calculations. Right motor and premotor regions were highly active in the more difficult condition of the transposing task. Multiple frontal lobe regions were highly active across tasks, including the left medial frontal area during both transposing and calculation tasks but the right medial frontal area only during calculations. In the more difficult calculation condition, right temporal regions were highly active. In coherence analyses and neural synchrony analyses, several similarities were seen across calculation tasks; however, latency analyses were sensitive to differences in task complexity across the calculation tasks due to the high temporal resolution of MEG. MEG can be used to examine musical cognition and the neural consequences of music training. Further systematic study of brain activity during high versus low memory load conditions of music and other cognitive tasks is needed to illuminate the neural bases of enhanced working memory ability in musicians as compared to non-musicians.

Language Mapping With Magnetoencephalography: An Update on the Current State of Clinical Research and Practice With Considerations for Clinical Practice Guidelines.

Numerous studies have shown that language processing is not limited to a few brain areas. Visual or auditory stimuli activate corresponding cortical areas, then memory identifies the word or image, Wernicke's and Broca's areas support the processing for either reading/listening or speaking and many areas of the brain are recruited. Determining how a normal person processes language helps clinicians and scientist to understand how brain pathologies such as tumor or stroke can affect changes in language processing. Patients with epilepsy may develop atypical language organization. Over time, the chronic nature of epileptic activity, or changes from a tumor or stroke, can result in a shift of language processing area from the left to the right hemisphere, or re-routing of language pathways from traditional to non-traditional areas within the dominant left hemisphere. It is important to determine where these language areas are prior to brain surgery. MEG evoked responses reflecting cerebral activation of receptive and expressive language processing can be localized using several different techniques: Single equivalent current dipole, current distribution techniques or beamformer techniques. Over the past 20 years there have been at least 25 validated MEG studies that indicate MEG can be used to determine the dominant hemisphere for language processing. The use of MEG neuroimaging techniques is needed to reliably predict altered language networks in patients and to provide identification of language eloquent cortices for localization and lateralization necessary for clinical care.

Additive Effects of Cointoxicants in Single-Opioid Induced Deaths.

A forensic drug database (FDD) was used to capture comprehensive data from all drug-related deaths in West Virginia, with deaths also included from the northern New England states of Maine, Vermont, and New Hampshire. All four states serve predominantly rural populations under two million and all have similar state medical examiner systems that employ statewide uniform death certification policies and practices. This study focused on 1482 single opioid deaths (fentanyl, hydrocodone, methadone, and oxycodone) in the FDD from 2007-2011. We modeled relationships between the opioid concentrations and the presence or absence of the following commonly occurring non-opioid cointoxicants: benzodiazepines (alprazolam and diazepam), alcohol, tricyclic antidepressants, selective serotonin reuptake inhibitors, and diphenhydramine. Additional covariates of state, age, body mass index, and sex were included. Results showed that the presence of alcohol, benzodiazepines, and antidepressants were each associated with statistically significant lower concentrations of some but not all of the opioids studied, which may obscure the interpretation of postmortem toxicology results alone. Fentanyl concentrations appeared to be the least associated with the presence or absence of the variables studied, and cointoxicant alcohol appeared to be associated with lower concentrations in opioid concentrations than were most of the other factors in the model studied. These findings underscore the importance of documenting all potential cointoxicants in opioid-related deaths.

An investigation of attentional contributions to visual errors in right "neglect dyslexia".

One type of error that is sometimes produced by patients with acquired dyslexia is the substitution of an orthographically similar word with letters that overlap the target either in early or late letter positions. When such errors affect the left sides of words, they are usually produced by patients with focal right hemisphere lesions who typically show evidence of left neglect in non-reading tasks. This pattern has thus been termed "neglect dyslexia". When the right sides of words are affected, however, patients frequently fail to show any signs of neglect in tasks other than reading. This study presents results from a patient with left hemisphere damage, and a very clear pattern of right "neglect" errors in reading, on a series of tasks testing attentional and imagery processes. Given the magnitude and consistency of the patient's reading errors, there was little evidence that these errors resulted from inattention to the right side of space or to the right side of an internally generated visual image. It is argued that the positional errors result from an impairment to an abstract ordinal code with graded activation of letter positions from first to last, and that this code is specific to tasks involving orthographic representations.

Magnetoencephalographic localization of the basal temporal language area.

Magnetoencephalography (MEG) recordings were made on 25 native English-speaking patients with localization-related epilepsy during a semantic language task (verb generation). Eighteen right-handed subjects with normal reading ability had MEG scans performed during the same language task. MEG data was analyzed by MR-FOCUSS, a current density imaging technique. Detectable MEG signals arising from activation in the left fusiform gyrus, also known as the basal temporal language area (BTLA), occurred at 167 +/- 18 ms (n = 43) in all subjects. The BTLA has been associated with a variety of language production and comprehension tasks involving processing of semantic, orthographic, and phonologic information. MEG may become an important tool in efforts to further define the linguistic operations of specific regions within this language area.

Language laterality determined by MEG mapping with MR-FOCUSS.

Magnetoencephalography recordings were made on 27 patients with localization related epilepsy during two different language tasks involving semantic and phonological processing (verb generation and picture naming). These patients underwent the semi-invasive intracarotid amobarbital procedure (IAP), also referred to as the Wada test, to determine the language-dominant hemisphere. Magnetoencephalography (MEG) data were analyzed by MR-FOCUSS, a current density imaging technique. A laterality index (LI) was calculated from this solution to determine which hemisphere had more neural activation during these language tasks. The LIs for three separate latencies, within each language task, were calculated to determine the latency that correlated best with each patient's IAP result. The LI for all language processing was calculated for the interval 150-550 ms, the second LI was calculated for the interval 230-290 ms (Wernicke's activation), and the third LI was calculated for the interval 396-460 ms (Broca's activation). In 23 of 24 epilepsy patients with a successful IAP, the LIs for Broca's activation, during the picture naming task, were in agreement with the results of the IAP (96% agreement). One of three patients who had an undetermined or bilateral IAP had an LI calculated for Broca's activation (396-460 ms) that agreed with intracranial mapping and clinical testing. These results indicate an 89% agreement rate (24 of 27) for magnetoencephalographic LI determination of the hemisphere of language dominance.

"Blocking" lexical competitors in severe global agraphia: a treatment of reading and spelling.

Severe global agraphia in Patient MM is analyzed via anagram spelling. Errors in word spelling reflect conflict among lexical competitors and "blocking" of semantic errors by sublexical and lexical cues. Lexical graphemic competition predominates in the context of MM's nearly absent sublexical transcoding of phonemes into graphemes. His orthographic lexicon is severely impaired, resulting in poor activation of lexemes and impaired activation and inhibition of the grapheme level in spelling. In MM's multiple revisions of spelling errors, graphemes from more than one lexical competitor persist in an active state simultaneously. Experimental treatment addressed MM's impaired sublexical reading and spelling, and facilitated sentence spelling through functional computer tasks. Spelling treatment resulted in evolution of MM's global agraphia to surface agraphia. MM's spelling performance supports the claim that lexical and sublexical processes interact during normal spelling, and shows that severe global agraphia is amenable to treatment.

The pathology of rotavirus-associated deaths, using new molecular diagnostics.

Rotavirus, the most common cause of severe, dehydrating gastroenteritis among children worldwide, annually causes approximately 500,000 deaths among children aged <5 years. The primary site of rotavirus infection is the small intestine. Pathologic investigations of patients who died of rotavirus infection are limited to data from a few reported autopsies, and dehydration with electrolyte imbalance is believed to be the major cause of death. Several recent reports suggest that children who died during a rotavirus illness were viremic before death, because rotavirus was detected at several extraintestinal sites. We report 3 rotavirus-associated deaths among children, 2 of whom had evidence of rotavirus genome in extraintestinal tissues detected by use of novel molecular diagnostic methods. The part played by rotavirus in fatal cases is unclear and requires additional investigation of diarrhea-associated deaths, because a better understanding might alter the approach to treatment and the need for antiviral therapy.